Vulnerable But Vigilant
A personal perspective
I believe that the coming weeks are very dangerous to our elderly and disabled community. Many people believe that the danger has passed; it has not. We should be even more vigilant to follow a strict adherence to the public health protocols. Social distancing, wearing a mask when outside of the home, hand washing, and sanitizing surfaces and objects can help to avert being infected.
As much as we can do for ourselves, and as much as we may do as a residential community, the solution lies in a national policy that adheres to science and the principles of public health.
But until we have universal compliance, extensive testing and contact tracing, an effective vaccine, and effective treatments, the danger will continue. And those of us who are vulnerable can choose to be vigilant and survive.
We, elderly and disabled persons, are highly vulnerable to COVID-19 because we have preexisting conditions which can make it harder to survive an infection. Our public and subsidized housing can become dangerous if COVID-19 enters. And medical protocols for dealing with scarce resources may doom us by withholding potentially life-saving treatments.
As governments loosen restrictions on interactions in public spaces and allowing some services to begin serving the public, many people are relaxing their guard. But for those of us who are vulnerable, this is a time of increased danger and if we are to survive, we need to be more vigilant.
We need to make every effort to avoid infection.
How COVID-19 spreads
COVID-19 is a dangerous disease caused by a virus. What is the best way to protect against infection? To answer that, we need to understand how it spreads and infects.
COVID-19 is able to infect a person, and that person can infect others even before symptoms have appeared. Breathing, talking, coughing and sneezing can all expel tiny droplets called aerosols that carry the virus and can infect nearby individuals. The smallest droplets are likely to travel as far as cigarette smoke, so even the recommended social distance of six feet may not be adequate to protect. Droplets that fall on surfaces can cause infection if a person touches the surface and then their face. But the main route for transmission is from person to person by way of aerosols.
Masks help to prevent infection
Properly fitted masks, even homemade masks, minimize the spread of aerosols and thus limit the exposure of others. According to research by Kimberly A. Prather and others, masking is a key to avoiding exposure.
"No masking maximizes exposure, whereas universal masking results in the least exposure."
"The distance from a smoker at which one smells cigarette smoke indicates the distance in those surroundings at which one could inhale infectious aerosols."
"Aerosols can accumulate, remain infectious in indoor air for hours, and be easily inhaled deep into the lungs.---Prather"
NEW MASK ADVICE FROM WHO (PDF file)
People who are 60 years or older, and people with underlying conditions, should wear medical masks when social distancing is not possible.
"In areas experiencing community transmission (a step below widespread transmission), individuals at elevated risk of severe COVID-19 disease or death, including those over the age of 60 or those with underlying health conditions, should wear medical masks whenever physical distancing from other people is not possible."
"The general public should wear masks in crowded areas when physical distancing from other people is not possible in areas experiencing widespread transmission."
"In terms of materials, the WHO now recommends that cloth masks be made out of at least 3 layers of different materials, ideally an inner layer of absorbent material (e.g., cotton), a middle layer of non-woven material (e.g., polypropylene), and an outer layer of non-absorbent material (e.g., polyester). WHO Director-General Dr. Tedros Adhanom Ghebreyesus emphasized that mask use alone does not protect against SARS-CoV-2 infection and that masks should be used as part of a “comprehensive strategy” of protective measures."--- Johns Hopkins Center for Health Security, daily update June 8, 2020.
Policy to prevent spread of infection
Therefore, since anyone may be infected but not showing any symptoms, everyone should wear a mask.
A rational policy would encourage or mandate that everyone should wear a mask when in the vicinity of others, and in closed spaces like elevators where aerosols may linger.
"Countries that have been most effective in reducing the spread of COVID-19 have implemented universal masking, including Taiwan, Hong Kong, Singapore, and South Korea."
"For society to resume, measures designed to reduce aerosol transmission must be implemented, including universal masking and regular, widespread testing to identify and isolate infected asymptomatic individuals."---Prather
Beliefs about "rights" that prevent masking
However, some people consider that they have a right not to wear a mask, and that no government or agency has the right to require them to wear a mask. This viewpoint is comparable to the belief that there can be no requirement not to bully – it is the right of free speech.
But when bullying and mobbing are not restrained, the victims are harmed and the social fabric is torn. Those who bully and those who are bullied live in a toxic community. Those who don't comply with the public health protocols on social distancing and masking threaten the health of others. The freedom of not wearing a mask can result in infecting others, possibly leading to their deaths.
No right is absolute. It is a widely accepted function of government to protect public health, even at the expense of an individual’s freedom, according to Cheryl Sbarra, J.D., Director Of Law And Policy, Massachusetts Association of Health Boards. Public health boards have the authority to regulate public health and safety, and this authority is expanded by order of Governor Baker in Massachusetts.
Wearers and non-wearers of masks are all members of the same community, but today each vilifies the others, and may even attack the other.
"[Some] consider the mandate to cover their faces a government overreach. Escalating tension over the precaution has spurred protests, rebellions, fights and even a fatal shooting."---Katie Shepherd, Washington Post
Politics, cultural wars, social class differences are all irrelevant to COVID-19. If we don't see everyone as part of the same "us," then COVID-19 will sicken and kill all of us.
According to Atul Gawande, MD, we must adapt the strategies for preventing the transmission of COVID-19 in the hospital setting to any residential setting, such as Lasell Village, a community for seniors. He notes that creating a new cultural norm in a community takes effort, persistence, and motivation. Anne Doyle, the president of Lasell Village, told Gawande,
“When you have a community that cares about each other, then people are interested in adhering [to the guidelines] for other people.”
Public health and networks
Public health uses a simple technique, contact tracing, to identify people who have been potentially exposed to a contagious disease. If implemented early in the spread of disease, it can be very effective and ending transmission in the community. Massachusetts is creating a new organizational structure for contact tracing.
New techniques for analysis of the data can provide additional understanding and can be applied to early discovery of new sources of infection. Valdis Krebs has described how disease can spread along a network. Disease, like gossip and other forms of information, spreads along networks of people who interact as individuals or within a small group. Testing to diagnose infected persons, including carriers without symptoms, is essential to control disease; when coupled with tracing of the contacts of an infected person, the methods of public health can identify sources of infection and work to isolate people to prevent further spread. The data about who is infected and who has died can be used to stop the spread of disease and prevent additional illness and death. But there must be a framework for rapid analysis and action that builds on testing and contact tracing.
Contagion in multifamily housing
In public and subsidized housing communities, we can predict the course of infection and disease, and we can act to prevent contagion.
But until we have universal compliance, extensive testing and contact tracing, an effective vaccine, and effective treatments, the danger will continue.
The more social interaction that takes place without strict masking and social distancing, the more likely it is that infection will strike and spread.
I suspect that the reason that some of the best-run assisted living facilities have been hard-hit by COVID-19 is that their hallmark has been creating vibrant social community life, ideal conditions for contagion.
Am I alone in my concern about the lack of safety?
In some housing programs, there is no continuing effort to assure compliance with safety protocols. Worse, there is no oversight and no effort to encourage compliance or if necessary, to sanction non-compliance.
This is a public health crisis. Where is the prevention activity? Where is the public health department or the state public health system? Prevention is so much easier than treatment. Any official of the local health department, or a community police officer could spend a few minutes chatting with a group of tenants, warning them about the dangers they are facing, and encouraging them to be mindful of the protocols. And mindful of the costs of a ticket!
Protocols for safety
Does the landlord clean and sanitize all high-touch surfaces several times a day? Is entry to the facility restricted to residents and essential service personnel? Are masks and hand sanitizer available? Is wearing of masks enforced? Are there services to enable tenants to remain isolated – meal delivery, food shopping and delivery, prescription delivery? Is there information, education, and support and is there counseling for emotional health? Is there testing of all tenants, staff, and service personnel on a regular basis?
We can make sure our landlords, local housing authorities, and management do their jobs to protect everyone.
Do tenants gather only when maintaining social distance and masking? With overlapping social groups/networks of 6-12 people, if any one is infected, they are probably all going to be infected. We could draw the contact tracing map in advance just by observing the daily interactions of neighbors.
We can set an example of appropriate behavior.
Baker, Governor Charles, COVID-19 order No. 31; requires wearing of face masks, enforceable by Department of Public Health, local health departments, and others.
Gawande, Atul, Amid the Coronavirus Crisis, a Regimen for Reëntry, The New Yorker, May 13, 2020
Kimberly A. Prather, Chia C. Wang, Robert T. Schooley, Reducing transmission of SARS-CoV-2, Science 27 May 2020: eabc6197, DOI: 10.1126/science.abc6197.
Krebs, Valdis, Transmission Network Analysis: tracking and stopping the spread of a contagious disease. http://orgnet.com/contagion.html
Krebs paper in PDF: http://orgnet.com/TNA.pdf
Sbarra, Cheryl, J.D., Director Of Law And Policy,
Massachusetts Association of Health Boards; LEGAL AUTHORITY TO REGULATE PUBLIC HEALTH AND
Shepherd, Katie, Masks become a flash point for protests and fights as businesses, beaches and parks reopen, Washington Post, May 5, 2020, https://www.washingtonpost.com/nation/2020/05/05/masks-protests-coronav…
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